MEDICARE: MRS. MARIA ALPENA BRIONES LEONIDAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	63936	CA

General Provider Information

NPI Number	:	1891078069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA ALPENA BRIONES LEONIDAS

Provider Business Mailing Address
First Line	:	602 10TH ST
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5104
Country	:	US
Telephone Number	:	530-743-2594
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 10TH ST
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5104
Country	:	US
Telephone Number	:	530-743-2594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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